<!DOCTYPE html>
<html lang="zh-cn">
<head>
    <title>最美医生推荐</title>
    <?php require 'templates/common/head.html'; ?>
</head>
<body>

<div class="container-fluid">
    <?php require 'templates/common/nav.html'; ?>
    <div class="panel panel-primary">
        <div class="panel-heading text-center">
            <h3 class="panel-title"><?php if($_GET['id']){ echo "修改";}else{ echo "添加";}?>医生咨询</h3>
        </div>
            <div style="padding: 30px 30px 10px;">
                <form action="" method="post" enctype="multipart/form-data" class="bs-example bs-example-form" role="form">
                    <input type="hidden" name="id" value="<?=$info->data['id']?>"/>
                    <input type="hidden" name="page" value="<?=$_GET['page']?>"/>
                    <div class="input-group">
                        <span class="input-group-addon">姓名</span>
                        <input type="text" class="form-control" value="<?php if($id){ echo $info->data['dc_name'];};?>" placeholder="输入序号" name="dc_name">
                    </div>
                    <br>
                    <div class="input-group">
                        <span class="input-group-addon">联系方式</span>
                        <input type="text" class="form-control" value="<?php if($id){ echo $info->data['dc_tel'];};?>" placeholder="输入联系方式" name="dc_tel">
                    </div>
                    <br>
                    <div class="input-group">
                        <span class="input-group-addon">描述</span>
                        <input type="text" class="form-control" value="<?php if($id){ echo $info->data['dc_descript'];};?>" placeholder="输入描述" name="dc_descript">
                    </div>
                    <br>
                    <div class="input-group">
                        <span class="input-group-addon">状态</span>
                        <select class="form-control" name="state">
                            <?php foreach($state as $k => $v): ?>
                                <?php if($v==$info->data['state']):?>
                                    <option selected value="<?=$v?>"><?=$v?></option>
                                 <?php else:?>
                                     <option  value="<?=$v?>"><?=$v?></option>
                                 <?php endif;?>
                            <?php endforeach;?>
                        </select>
                    </div>
                    <br>

                    <div class="input-group">

                        <span class="input-group-addon">推荐人姓名</span>


                        <input type="text" class="form-control" name="referrer" value="<?=@$info->data['referrer']?>">
                    </div>
                    <br>
                    <div class="input-group">
                        <span class="input-group-addon">推荐人联系方式</span>
                        <input type="text" class="form-control" value="<?php if($id){ echo $info->data['referrer_tel'];};?>" placeholder="输入联系方式" name="referrer_tel">
                    </div>
                    <br>
                    <h3>审核结果通知</h3>
                    <div class="input-group">
                        <span class="input-group-addon">医生电话</span>
                        <input type="text" class="form-control" value="" placeholder="输入接收信息人的电话" name="send_tel">
                    </div>
                    <br>
                    <div class="input-group">
                        <span class="input-group-addon">短信内容</span>
                        <textarea class="form-control" rows="3" cols="28"   name="send_tel_content"></textarea>
                    </div>
                    <br>
                    <div class="input-group">
                        <span class="input-group-addon">推荐人电话</span>
                        <input type="text" class="form-control" value="" placeholder="输入推荐人电话" name="send_re">
                    </div>
                    <br>
                    <div class="input-group">
                        <span class="input-group-addon">推荐人短信内容</span>
                        <textarea class="form-control" rows="3" cols="28"   name="send_re_content"></textarea>
                    </div>
                    <br>
                  <!--  <div class="input-group">
                        <span class="input-group-addon">联系方式</span>
                        <input type="text" class="form-control" value="<?php if($id){ echo $info->data['dc_tel'];};?>" placeholder="输入医生的联系方式" name="dc_tel">
                    </div>
                    <br>
                    <div class="input-group">
                        <span class="input-group-addon">推荐人姓名</span>
                        <input type="text" class="form-control" value="<?php if($id){ echo $info->data['referee_name'];};?>" placeholder="输入推荐人姓名" name="referee_name">
                    </div>
                    <br>
                    <div class="input-group">
                        <span class="input-group-addon">推荐人联系方式</span>
                        <input type="text" class="form-control" value="<?php if($id){ echo $info->data['referee_tel'];};?>" placeholder="输入推荐人联系方式" name="referee_tel">
                    </div>
                    <br>-->

                    <div class="input-group">
                        <input type="submit" class="form-control btn btn-primary" value="提交">
                    </div>
                </form>
            </div>
    </div>
</div>
<?php require 'templates/common/foot.html'; ?>
</body>
</html>